Doctors who want to keep patients from becoming dependent on opioid painkillers should not provide refills to the addictive drugs for those just starting on the medication, a new study advises.
Clinicians should think twice before prescribing opioids, but if they do, they should err on the side of caution to when deciding dosages and whether to provide subsequent refills, according to the study published in the Journal of General Internal Medicine. The study’s findings support guidelines released in March by the Centers for Disease Control and Prevention (CDC) to curb widespread opioid abuse. The guidelines advised primary care clinicians to prescribe treatments other than opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life care, to prescribe the lowest effective dosage and limit prescriptions for acute pain to no more than seven days.
Researchers used data from Oregon, the U.S. state with the highest rate of non-medical opioid users in a 2012 survey, to look at how much and for long opioids can be prescribed for the first time to so-called opioid-naïve patients without their becoming long-term users.
Given the country’s epidemic of overdoses and addiction that resulted from increased opioid prescriptions, doctors are trying to protect patients from becoming dependent on painkillers.
Researchers analyzed data from Oregon’s prescription monitoring program for outpatient prescriptions for controlled substances, including opioids. In one year, 3.6 million opioid prescriptions were filled for 874,765 patients. Of those, over 500,000 were patients using such drugs for the first time. Of that group, 26,785 or 5.0 percent became long-term opioid users who received six or more opioid refills within one year.
The researchers found that the risk of long-term use can be minimized by starting a patient off with a single prescription of a short-acting opioid with no refills. The cumulative dose should be less than 120 morphine equivalents. Long-acting opioids were associated with a higher risk for long-term use than short-acting drugs.
“The increasing risk of long-term use even at low cumulative doses supports the [CDC’s] recommendation of limiting therapy to three to seven days for most patients,” Richard A. Deyo, M.D., the lead author of the study from the Oregon Health and Science University, said in an announcement. “Our data suggest the value of attention to high-risk prescribing, over which clinicians have greater control. This in part reflects concern that we are dealing with risky drugs, not risky patients.”
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